Weight changes, illness, and “diabulimia”

I’d been putting it off, but finally got some more glucose test strips today. Surprise, surprise: my first reading this morning was 14.7/265. Yeah, I did finally order some strips (can’t get them free from the NHS without seeing the GP) because I’d been noticing symptoms again. I had been managing things pretty well without meds. Stress over the upcoming move* is probably a big culprit.

Yeah, I need to try to get some more Januvia when I see the GP about the mole. *grimace* That may be prove to be even more fun since he seemed really keen on keeping me on Glucophage. I got the Januvia–not nearly as cheap–when I was in the US, and it didn’t have any obvious side effects whatsoever.

Not surprisingly, one of the more obvious symptoms has been losing more weight I didn’t have to spare, while being hungry all the time and specifically craving fats and protein. Good old polyphagia was, indeed, a dead giveaway. Why do I mention this? That’s also one of the reasons I’d been putting off doing much about it. Perverse programming insists that losing weight to the point of some weakness, breast shrinkage (last fat reserve, with no hip deposits), and a sinking-in face is desirable. I may know rationally that this is absolutely ludicrous, but the nagging little voice is still there. I am still fighting the impulse to restrict my food intake, knowing full well that I am peeing out more energy in glucose than I am able to take in.

This is some scarily strong programming. It’s easy enough to blame the individual for perceived craziness, but it’s a not at all uncommon form of craziness. I know at least one woman with Type 1 diabetes IRL who has repeatedly ended up in the hospital because of trying to maintain her glucose levels so high, for weight reaons. This is also recognized as a probable cause of a lot of complications among diabetic women, and is common enough to have been termed “diabulimia”. According to the first link, women with Type 1 are already at 2.5 times the risk for eating disorders.

Eating disorders also go along with Type 2, not surprisingly, and I strongly suspect that binge eating (probably triggered initially by hypoglycemia) is the least of it. Especially given the popularity of blaming Type 2 diabetes on being fat–with all those negative and sometimes racist connotations–rather than looking at the fact that developing insulin resistance directly makes the body deposit fat in the abdomen. It’s popular to blame us for getting diabetes in the first place–by being wrong-shaped, fat, lazy, frequently non-White slobs–and then blame us for staying diabetic because it’s hard to get rid of the abdominal deposits once the insulin resistance has put them there. That’s not only a mess of woolly thinking and post hoc fallacies masquerading as medical fact, it’s a recipe for disaster.

I would be astounded if these “diabulimic” women did not know that they were risking complications. Obviously, the perceived rewards of reducing one’s body mass–e.g., hoping they won’t get treated like crap as much–outweigh the risk of eventual complications, not to mention just feeling bad day to day because their blood sugar is out of whack. That choice may be based on some faulty premises, but there it is. And we didn’t come up with those faulty premises out of thin air, no matter how tempting it is to treat this as an individual psychological quirk. Fact is, you will get treated differently based on body mass.

The truly frightening thing here? I recognize that my continuing preoccupation with body mass is manipulated and almost completely bogus. I can see that this particular button was installed as a means of social control. Controlling one’s body mass is presented as a substitute for real control over one’s life, while diverting all that time, attention, money, and energy down a rathole. I still haven’t managed to deactivate that button (yet). Scariest, most of the other women harming themselves because of this manipulation are still taking it seriously.

Trying not to write a book, I will mostly stay away from the sickness of weight loss from any health problem whatsoever, including cancer or Crohn’s, being considered a good thing. I have read at least one great post on the comments other people have felt free to make about weight loss from illness, but can’t locate it right now. I’ve witnessed this myself, and been on the end of it multiple times. On the slightly less serious end, my grandmother openly advocates the loss of appetite or gastric distress that goes along with a case of the flu as a great opportunity to keep one’s food intake reduced afterward. Seriously.

Incidentally, I have become angrier about this sort of thing lately, having realized that the only “weight problem” I had when I was younger came as a result of being given a lot of endocrine disrupting medications. (Even better, before my body had reached any kind of adult equilibrium, which is why I am particularly concerned about giving this stuff to kids even before puberty.) The social programming is strong enough that medical professionals gave me dirty looks and offered referrals to dieticians, when I was seeing them about endocrine problems that will (a) directly cause insulin resistance, and (b) make you gain scads of weight in a short amount of time. When even medical professionals who should know better are treating sick people like lazy slobs, there’s a problem.

Even now, writing that post about endocrine disruption, I realized later that I’d avoided mentioning that I got up to almost 260 lbs. for a while there, and spent years hovering around 230–in a distinctive steroid distribution. At 5’8″. It just struck me a couple of days ago that, yes, I really have lost almost 100 lbs. from my top weight. (Regained some, but I needed to.) Some of this has come from the logical result of all those years of med-induced insulin resistance–i.e., diabetes–but most of it has been a direct result of just stopping meds which were obviously screwing with my endocrine system. I probably had the full-blown diabetes for 5+ years before it was diagnosed, anyway, especially since they rarely think to look for it if you’re in your 20s. Julia at Cancer Vacation, writing about weight gain from steroids used for cancer treatment, makes the excellent point that we women frequently feel too ashamed to even talk about weight gain as a symptom, with the reassurance: “You didn’t do anything wrong to gain the weight and lots of other women are struggling with the same issues. If your friends imply that you just need to eat less or exercise more you can point them here. With your middle finger.” I thought I was over that shame, but apparently not completely.

Not incidentally, these themes are also behind my levels of frustration at having medical professionals stop at “BMI: 28”, and give me grief about it. I’m also still hesitant to admit that I now weigh about 180, but that doesn’t change the fact that I’m also on the verge of too thin to be healthy ATM. Treating people who really are fat that way is just plain wrong, but it particularly chaps my hide when I’ve lost muscle mass, my face is sinking in, my big bony arms are sticking out of a short-sleeved shirt–and the doctor is congratulating me for losing 15 lbs. in a month from the diabetes. I can’t make this crap up.

When I was at a fairly healthy weight for me–and under 20% body fat–two different NHS doctors yanked my birth control pills because I was “too fat and old”, at 28. Both incidents had more to do with punishment for just saying “no, this is unacceptable”, but both of them felt free to openly use weight as a bludgeon. They probably would have done the same to a woman whose BMI translated as “underweight”, if she dared to know anything about her own health and stayed assertive about it. This combo of fat and old is intended as the ultimate smackdown for a woman, and it works all too well. One of them used this verbal abuse to manipulate me into taking an IUD I had clearly and repeatedly said that I did not want and was unlikely to be able to tolerate. (More like stunned me with her inordinate hostility to the point that I couldn’t resist, then and there. I ended up removing it myself, after about a year of exactly the kind of nasty and painful effects I’d experienced before from unopposed progesterone.) There are so many things wrong with this picture.

These kinds of experiences do highlight the fact, though, that especially when they’re looking at women it’s total body mass they’re concerned about, rather than body fat. And just how acceptable it has become to manipulate women with this largely manufactured concern.

Edit: Ye gods, the first result coming up with the “possibly related posts” feature is a doozy: The End of BMI? Know Your Maximum Weight Limit. Not surprisingly, that still does not adjust for frame size or musculature, and uses different baselines for men and women. Wow, a quick search turns up that Weight Watchers is actually following evidence and using the same figures for both sexes: “Since men tend to ‘look better’ at a higher BMI than women, it seems intuitive that the healthy weight for a man of the same height as a woman would be higher. But this is not the case.”

Then there’s the seriously twisted “pregorexia”, in case anybody was still doubting there’s an awful lot of misogyny around. My mom was sick enough through her whole pregnancy that she lost 40 pounds–and got an awful lot of comments about looking great and its taking no time to “get her figure back”. (Not that she wanted it back.) The OB didn’t act very concerned that she could only keep down a few fried potatoes; it was lucky that her body had plenty of resources to draw on going in, including bone mass/density. That was 1974-75, and things look worse now on the preoccupation with body mass front.
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* I was going to link to Nigel’s LJ, but the entry is locked. He got a job offer in Mountain View, CA, so we’re moving after his visa goes through. Tentative start date is 11 January, assuming he’s got the visa. Not entirely without stress, especially with the state this house is in!

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Wow, two doctors told you you were “too old” for birth control at age twenty-eight?

That’s bizarre, and seems to me to derive from a very backlashy understanding of women’s fertility.

Just because we might not be at our peak fertility levels once we hit thirty, that doesn’t mean we become infertile. Lots of women have babies in their thirties, and I think it’s irresponsible for a doctor to tell a woman who is trying not to become pregnant that she can stop worrying once she hits thirty!

(I am the eldest of three children, all born to a mother in her mid-to-late thirties.)

I could tell at the time that both of them were using that as a blatant bullying tactic–“If I insult you badly enough, you’ll shut up and do as I say.” In one case, from an actual GYN, that involved a lower longterm cost alternative to pills (Mirena), whether I could tolerate the progestin-without-estrogen or not. (I had to wonder if she was getting some kind of kickbacks, honestly; she wouldn’t even give me a copper IUD instead.) I was still on anticonvulsants at the time, and needed a higher-dose combined pill, which the GP did not want to prescribe. Instead of looking at other options since he was uncomfortable with that, he declared me “too fat and old” for any combined pill and sent me home with progestin-only pills over protests that I hadn’t reacted well in past. (Come to find out, not only will progestin-only methods increase risk of insulin resistance and diabetes, the type of adverse effects I had are a sign that you already have it.) They both did send me home with some form of birth control, after not-so-subtly suggesting that it was amazing that I would need it at all. Since the Mirena disaster, I haven’t wanted to try again. Good thing condoms work. After all the endocrine uproar, I may well be infertile anyway, but am not about to find out the hard way!

I’ve run into a lot more outright bullying and God complex dealing with some (not all) NHS doctors, and have been repeatedly shocked. It doesn’t help that I just freeze up, after too much experience with bullies. I suspect the different behavior has a lot to do with not having to view patients as customers who can choose to pay someone else instead; it’s not easy just to see another doctor if they have a lousy bedside manner, plus I suspect some “DMV Employee Syndrome”. Fouled-up as the system is in the US, that’s one serious drawback to the “HMO From Hell” NHS model. There’s not nearly as much incentive to treat patients decently.

That said, I have also noticed more signs of backlashy approach to that kind of thing, even coming from medical people. Part of this may be coming from local socioeconomic factors, but there do seem to be an awful lot of SAHMs in their 20s with several children, frequently stairsteps. A lot of people, including doctors and PT people, have acted surprised that (a) I don’t already have kids, and (b) I don’t want them anytime soon. Mostly for health and support reasons, it just doesn’t seem like a great plan; you’d think that health professionals would see this. 😐

My (older and fatter) aunt, who’s in health care herself, almost rolled in the floor laughing at the “too fat and old” combo. Then suggested filing grievances.

On second thought, not so much. There are very conspicuous Essex girls, but we’re living just inside the M25. Apparently, one of the reasons there are also so many middle-class SAHMs around is that the location is seen as a good compromise for raising kids–just suburban enough, but still a very reasonable commute. For that matter, I have been impressed at how many of the commuting middle-class dads appear 10+ years older. 😐 Cultural differences more than anything else, I suppose, along with my being used to >5 year gaps between kids being considered best.

It was a Mirena, and I assumed I needed to go back in and try to convince the GYN to remove it. But I did some research, and since they’re all flexible plastic, the way professionals remove them is by carefully pulling on the string! (As described here.) It didn’t even hurt, which was a bit of a surprise. I would not recommend that anyone else try this at home.